Faculty Publications


Depression in children and adolescents: REBT approaches to assessment and treatment

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Rational Emotive Behavioral Approaches to Childhood Disorders: Theory, Practice and Research

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These words describe how many depressed young clients feel as they struggle with depression, which has become increasingly prevalent with this population, especially among adolescents (Koplewicz, 2002; Lambert and Davis, 2002; Stark et al., 2000). Recent statistics indicate that anywhere from 10 to 15% of the child and adolescent populations have some signs of depression (Koplewicz, 2002). According to Koplewicz, it is still relatively rare among children and preteens, but Stark and his colleagues noted that the age of onset is earlier than previously thought, with prevalence progressively increasing until early adolescence, when the rate rapidly escalates and continues through late adolescence. Reinecke et al. (1998) stressed that depression is a serious condition that necessitates timely intervention, and Evans et al (2002) posited that "Depression may be one of the most overlooked and under-treated psychological disorders of adolescence" (p. 211). Although currently there is general agreement that childhood depression exits, until the late 1960s, there was controversy regarding its existence prior to late adolescence or early adulthood (Evans et al., 2002; Parry-Jones, 2001; Shaffer and Waslick, 2002). In fact, Merrell (2001) pointed out that there was "widespread denial that certain types of internalizing disorders, such as depression, could even exist in children" (p. 1). A common belief was that children and adolescents were basically immune from depression because after all, childhood is a happy, carefree time, so what is there to be depressed about? And everyone knows that adolescents are moody, but isnt that just part of growing up? These beliefs reflect several major misconceptions: one, that depression is caused by something, so if there are no disturbing events in childrens lives they wont be depressed; two, that disturbing events themselves cause depression; and three, that adolescent depression is just normal moodiness. In responding to the first two misconceptions, it is true that situations can be trigger events for depression, but there are also biological, (Thase and Howland, 1995), neurochemical (Ingram and Malcarne, 1995; Koplewicz, 2002), and genetic factors (Ingram and Malcarne). In addition, there are cognitive components to depression that cannot be ignored (Engel and DeRubeis, 1993; Stark et al., 2000). In fact, "cognitive theory suggests that negative thinking plays a pivotal role in the development and/or maintenance of depression" (Rush and Nowels, 1994, p. 3). With regard to the third misconception, there is a significant difference between "normal" adolescent moodiness and depression, which is more severe, atypical, and must be taken seriously (Koplewicz, 2002). It is the most common mental illness among teenagers and is more than "just teenagers with growing pains or in a moody stage" (Evans et al., 2002, p. 211). The purpose of this chapter is to describe what depression is and who is most vulnerable, how depression is manifested in children and adolescents, a rational-emotive behavioral perspective regarding the etiology and assessment of depression, and developmentally appropriate interventions. The chapter concludes with a case study illustrating the assessment and intervention process with a depressed adolescent. © 2006 Springer Science+Business Media, Inc.

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